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Inspection on 06/06/05 for St James Park Nursing Home

Also see our care home review for St James Park Nursing Home for more information

This inspection was carried out on 6th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People considering moving into the home are provided with clear information and a detailed assessment to assist them when trying to decide if St James Park is the right home for them and able to meet their health and care needs. Residents and visitors spoken with had seen a copy of the document and agreed that it was `very useful`. Social activities provide variation and interest for the residents living in the home including outings and events that involve relatives and friends. The home has a written complaints procedure that is included in the service users guide. A resident who had cause to make a complaint commented that `it had been dealt with very quickly and very well`. Appropriate checks are being undertaken prior to the member of staff commencing employment and training is provided to ensure that residents are protected and staff are competent to do their jobs.

What has improved since the last inspection?

The records of all medicines administered are now checked daily to ensure all residents receive the medicines prescribed for them. A manager has been appointed and has applied to the Commission for Social Care Inspection for registration. One resident commented `home well run` and a visitor to the home said ``Liz new manager very good and approachable`.

CARE HOMES FOR OLDER PEOPLE St James Park Bradpole Bridport Dorset DT6 3EU Lead Inspector Chris Gould Unannounced 6 June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St James Park Address Bradpole Bridport Dorset DT6 3EU 01308 421174 01308 427564 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes (CFC Homes) Limited Mrs Karen Elizabeth Pearson CRH (N) - Care Home With Nursing 46 Category(ies) of OP - Old Age (46) registration, with number of places St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 15 March 2005 Brief Description of the Service: St James Park is a large residential home registered to provide nursing care to a maximum of 46 elderly people. The home is situated in the quiet country village of Bradpole, a short drive away from the town of Bridport. The accommodation is arranged over three floors and a passenger lift provides access to all floors of the home. There are 30 single and six double bedrooms; most have en-suite facilities. Communal rooms include a lounge, library, conservatory style dining room, three communal lounges (including one with a large dining area), five assisted bathrooms and one assisted shower. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over eight hours on one day in June 2005. This inspection assessed 18 standards and the outstanding requirements from the previous inspection. A tour of the premises took place and three staff files and three residents care records were inspected. Nine residents, two visitors to the home and the staff on duty were spoken with during the inspection. Liz Wilson the proposed registered manager was on duty and assisted in the inspection process throughout the day. The home’s occupancy was thirtyseven older people on the day of inspection. What the service does well: People considering moving into the home are provided with clear information and a detailed assessment to assist them when trying to decide if St James Park is the right home for them and able to meet their health and care needs. Residents and visitors spoken with had seen a copy of the document and agreed that it was ‘very useful’. Social activities provide variation and interest for the residents living in the home including outings and events that involve relatives and friends. The home has a written complaints procedure that is included in the service users guide. A resident who had cause to make a complaint commented that ‘it had been dealt with very quickly and very well’. Appropriate checks are being undertaken prior to the member of staff commencing employment and training is provided to ensure that residents are protected and staff are competent to do their jobs. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 and 5. The home does not provide intermediate care therefore standard 6 is not applicable. Systems are in place to ensure that the resident has the information they need to make an informed choice about where to live and that the home they are moving into is suitable and will meet that their care needs. EVIDENCE: The home has a BUPA corporate brochure with additional information relating to St James Park. A copy is provided for all prospective residents and provides a comprehensive service users guide. Residents and visitors spoken with had seen a copy of the document and agreed that it was ‘very useful’. A copy is available on a table in the main reception area. The service users guide requires minor alterations to ensure that it relates to the practices within the home. The care records of a resident recently admitted included a pre admission assessment. Discussion with staff confirmed that they were aware of the resident’s needs at the time of their admission. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 9 Residents and visitors spoken with said that they had visited the home before a decision was made to move in. One commented ‘it was recommended and we are not disappointed’. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The absence of a clear and consistent care planning system to adequately provide staff with the information they need to satisfactorily meet residents’ needs has the potential to place residents at risk. Residents are not protected by the systems in place to ensure the safe administration of medication as they are not consistently reflected in the home’s care practices. Residents feel they are treated with respect and their right to privacy is upheld but this is not consistently reflected in the home’s care practices. EVIDENCE: All residents have individual plans of care. Two of the three residents care records inspected had not been reviewed monthly. Assessments had been undertaken but care plans did not consistently detail how identified needs were to be met. The care plan of one resident who requires assistance with managing their continence did not reflect the actual care provided. The documentation issued has a section for the resident or their representative to sign but this had not been completed. Residents spoken with were not aware of their care plans. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 11 Two residents care records identified that they had wounds but there was no wound assessment or plan of care available. Changes identified when the care plans have been evaluated had not initiated a change in the plan of care. One resident’s mobility had decreased but this was not reflected in the care plan. One resident’s pressure risk assessment showed a fluctuating score but there was no evidence to support the changes. The home has a procedure for the administration of medication and the Medicines Administration Records inspected had been appropriately completed. The records are now monitored on a daily basis following recent discrepancies. During the mid day administration of medication the trolley was left unattended, unlocked and open in the dining area where there were a number of residents and visitors. The home does not have a system in place to audit medicines not provided in the Monitored Dosage System (MDS) blister packs. New medicine trolleys are being ordered specifically designed to be used with the ‘blister pack’ method used to package the medication. The maximum and minimum temperature of the medicines refrigerator is now monitored and recorded daily. A number of the residents’ rooms contained continence products on view to anyone visiting the room. Storage is a problem in some rooms but Liz Wilson said that they are looking at ways to resolve it. Staff were seen knocking on residents doors and waiting for a reply during the inspection but there were a number of occasions when this did not happen and staff just opened the door and walked in. Discussion with residents confirmed that they are asked what name they wish to be addressed by and that this was always used. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 13 Social activities provide variation and interest for the residents living in the home. Residents are able to maintain contact with their family and friends and to go out into the community if they wish and are able. EVIDENCE: The home employs an Activity Organiser for thirty hours a week. An activities programme is displayed in the foyer and a monthly newsletter is produced. Events planned until the end of June include an outing, a musical afternoon and a quiz night and raffle. A copy of the May 2005 newsletter was available in the service users guide provided in the foyer. The activities room has been extended to include an area to be used for hairdressing. A hairdresser visits every Monday and was present on the day of inspection. The facility was very much appreciated by the residents who visited the hairdresser. The activities room was in use throughout the day. A number of residents spoken with all agreed that they enjoyed the activities especially bingo and the outings. The book in the reception area contained the names of residents’ visitors to the home and relatives spoken with said that they are made very welcome at any time. Residents are able to go out on their own if able or with a relative or friend. One resident said that he goes into Bridport when he needs to. Relatives and friends are invited to activities within the home and outings are arranged for residents. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The systems in place provide residents with the confidence that their complaints will be listened to and acted upon. Arrangements for protecting residents from abuse are not satisfactory placing them at possible risk of harm. EVIDENCE: The home has a written complaints procedure that is included in the service users guide providing the address and telephone number of the Commission for Social Care Inspection, a description of how complaints may be made and confirms all complaints will receive a response within 28 days. A resident who had cause to make a complaint commented that ‘it had been dealt with very quickly and very well’. A national agreement between BUPA and CSCI is being sought regarding BUPA’s abuse policy and its contents. Staff have not received training on the prevention of abuse but this is planned to take place in the near future. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 25 and 26 Actions need to be taken to ensure that the environment the residents live in is well maintained, comfortable, clean and safe. EVIDENCE: Since BUPA purchased the home a programme of refurbishment has been undertaken. Residents commented ‘I like it here’, ‘can’t be better’ and ‘like home. A maintenance person is employed full time to ensure that the documented programme of routine maintenance and the improvement plan are carried out. The double door leading into the lounge was not shutting to latch at the time of inspection and a resident’s bedroom door was wedged open with a small suitcase that could place residents at risk in the event of a fire. A requirement that the obstruction was removed immediately was issued. The wall underneath the bay window in the lounge has signs of damp and the wallpaper is coming off the wall. Plans are in place to remedy this and make St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 15 good the wall decoration. There are plans in place to unblock all the gutters that overflow as they have become full of leaves and other debris. One bedroom has only a low level of natural light as a brick wall is less than two metres distant from the window and obscures the view. This is being addressed by painting the wall white and encouraging plants to grow down the wall. This action plan has still to be fully completed. The resident occupying the room confirmed that he is happy with the level of light in his room but the light levels still remain very low with a poor outlook from the window. Cleaners and a dedicated laundry person are employed Monday to Friday but not during the weekend. The inspection took place on a Monday and it was apparent that the floors had not been cleaned recently including food spillage. A system for identifying bedrooms that were ready to be cleaned and those where the resident was still receiving care is used but the signs on the doors remained unchanged throughout the day. The home is in the process of employing staff to cover the weekends. The home has an infection control policy and there were no malodours noted while touring the home. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 The numbers and skill mix of staff do not meet the needs of the residents. Appropriate checks are being undertaken prior to the member of staff commencing employment to ensure residents are supported and protected. Training is provided to ensure staff are competent to do their jobs. EVIDENCE: The hours of care provided and the skill mix of staff have recently been reviewed resulting in the recruitment of additional staff. The manager said that the night staff report that they do not have sufficient staff at night. The staffing levels issued by the previous regulator, the Dorset Health Authority state that for thirty seven residents from 20.00 until 08.00 the staffing levels should be one registered nurse and four care assistants with a total staff of five. The home has four staff on duty during the night time period. Cleaners and a dedicated laundry person are not employed on Saturday and Sunday. This has been identified during the recent review and will be addressed. Residents commented that although call bells are generally answered fairly quickly as they require two carers to assist them the carer leaves to find a colleague and it is quite a while before they return. Three staff files were inspected and they all contained the relevant documentation and checks required including a satisfactory enhanced Criminal Records Bureau or POVA first check obtained prior to the member of staff commencing employment. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 17 The home has a comprehensive induction and ongoing training programme. This was confirmed in discussion with staff who all agreed that they are provided with good training opportunities. One care assistant who has obtained her NVQ levels 2 and 3 in care is now undertaking the NVQ assessors course and another care assistant has recently completed the manual handling trainers course. First aid training had been provided the previous week. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 The management of the home is undertaken by a person who is of good character and able to discharge her responsibilities fully while being supported during her induction. Systems are in place but the safety and welfare of residents and staff are not consistently promoted and protected. EVIDENCE: Liz Wilson has recently been appointed by BUPA as the manager of St James Park and has applied to the Commission for Social Care Inspection for registration. The manager is a first level nurse who is commencing the NVQ level 4 in management. One resident commented ‘home well run’ and a visitor to the home said ‘’Liz new manager very good and approachable’. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 19 There was evidence that regular meetings were arranged for all staff according to the departments in which they worked in the home and this was confirmed in discussion with staff. The manager has support provided by managers within BUPA during her induction period. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 1 x x x x x 2 2 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x x x x x x St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15(1)(2) Requirement The registered person shall ensure that residents care plans contain sufficient detail to provide clear guidance to staff on the actions to be taken to meet their care needs Care plans must routinely evidence the involvement of service users and/or their representatives: the manager or key worker must clarify if the service user/or their representative would like a copy of the updated care plan. The registered person must ensure that proper provision is made for the health care and where appropriate treatment of residents. The registered person shall ensure that medicines are stored, handled and administered safely. The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of residents. Cupboards must be supplied so that sundry items in regular use St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 22 Timescale for action 30 September 2005 2. 8 12(1) 30 September 2005 30 September 2005 30 September 2005 3. 9 13(2) 4. 10 12(4)(a) 5. 18 18(1) 6. 19 23(4) 7. 8. 19 19 23(4) 23(2)(b) 9. 25 23(1)(a) 10. 11. 26 27 23(2)(d) 18(1)(a) are stored more discretely in service user ‘s rooms or ensuites. The previous timescale of 30.06.05 has been extended. All staff must be supplied with training relating to the identification and prevention of abuse. The home’s BUPA policy on the protection of vulnerable adults must be updated to make reference to the POVA scheme, the local ‘No Secrets ‘guidance and Whistle Blowing: staff must sign to acknowledge that they have read and understand the content of this policy. The registered person shall ensure that fire doors are not held open by any means that would prevent them from automatically closing in the case of a fire. The registered person must ensure that all fire doors close to latch. The cause of damp in an area of the ground floor lounge must be identified and eradicated and the wallpaper in the affected area must be made good. The registered person must take action to improve the level of light and the view from the residents window as identified during inspection. The previous timescale of 30.06.05 has been extended. The registered person shall ensure all parts of the home are kept clean. The registered person shall, ensure that at all times the numbers and skill mix of the staff deployed are sufficient to meet the needs of the residents. 30 September 2005 immediate 17 June 2005 30 September 2005 30 September 2005 30 September 2005 30 September 2005 St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 9 Good Practice Recommendations It is recommended that the home should have a clear audit trail for medicines not in the Monitored Dosage System (MDS) blister packs e.g. dating packs when they are started or entering a carry forward balance on the MAR chart and this should be monitored to ensure medicines are given correctly. St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole Dorset BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St James Park D55 S20498 St James Park V230610 060605 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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